Podcast: Your Leader Is More Important Than Your Doctor

April 13, 2023
  • Brent Stewart
  • Brent Stewart
    Digital Strategy & Content Leader at Barry-Wehmiller

Did you know that the person you report to at work can be more important to your health than your family doctor?

That statement comes from the research of Dr. Casey Chosewood, the Director of the Office for Total Worker Health at the National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention.

It sounds outrageous, but it underscores one of the profound truths we’ve discovered at Barry-Wehmiller: That the way we lead impacts the way people live.

Most leaders understand their influence on team members’ lives during work hours, but often enough, they don’t think about how their leadership affects those team members outside the workplace as well. And, that extends to the health and wellbeing of those team members. We talk often about workplace stress and the links between stress and health. Stress often leads to or exacerbates health issues, and what’s one of the leading causes of stress? Work!

The American Institute of Stress says that “Numerous studies show that job stress is far and away the major source of stress for American adults and that it has escalated progressively over the past few decades. Increased levels of job stress as assessed by the perception of having little control but lots of demands have been demonstrated to be associated with increased rates of heart attack, hypertension and other disorders.”

Barry-Wehmiller CEO Bob Chapman participated in a webinar hosted by the National Institute for Worker Safety and Health moderated by Dr. Chosewood. It was a discussion between Bob and Jeffrey Pfeffer, author of Dying for a Paycheck: How Modern Management Harms Employee Health and Company Performance―and What We Can Do About It. You can watch it here.

This podcast, is a companion to that webinar. It features an in-depth discussion between myself, Mary Rudder and Dr. Chosewood about the links between the workplace and wellness. He talks about the Total Worker Health initiative and discusses the linkage between team member wellbeing and their supervisor. He starts out by addressing the statement that your leader is more important than your primary care physician.



Dr. Casey Chosewood: I think it is quite an intriguing statement, and every time I say it, it certainly gets a lot of attention. I think it's one of those kinds of statements that really stop and make you think about how important the exposure of work is to your overall day-to-day and long-term health and well-being, and certainly, our research at NIOSH and decades of research by others, I think would bear that statement out as true for most workers in the country today. Many folks see their doctor maybe once or twice a year, perhaps less frequently for a full physical or a full evaluation of their overall well-being. That certainly was true when I practiced family medicine for more than a decade. I would see patients once a year or a few times a year, and it was quite frustratingly limited how much actual influence I could have on their overall health, especially when you compare the influence that the exposure of work itself, which we know is a huge social determinant of our health.

That exposure of work is so pervasive, it consumes so much time in our lives, that it is a very powerful influence, if you will. So I compared my experience as a doctor in someone's life to the experience that someone has through their supervision, through their leader at work. Workers see supervisors and are influenced by working conditions that he or she controls multiple times every day, hundreds of times per year. Our jobs dictate our income. They are a huge predictor of how much exposure to risk we have, how likely we are to be injured, given our work is controlled by that exposure. How much time we spend away from other healthy pursuits is oftentimes dictated by how much work exposure we have, things like how much time is left over after our commutes and after our schedule's completed, how much time is left over for physical activity, or for pursuing healthy meals. Whether or not we have adequate healthcare benefits, very strongly influenced by whether or not we have a job that offers those benefits.

So when you add all that together, it's not a far leap to say that the exposure of work and the person who controls so many elements of that has a strong overall influence on our overall health. One last thing I would say about this is the job we have dictates so many other choices and decisions. Very few things will make you pick up and move far away from family or friends, leave behind all your social support systems, and move to a brand new community and put yourself down to set up a new life, but a job will do that. A job is so powerful when it comes to all of the other choice-making around the trajectory of our life, and for those reasons, that, along with some of the emerging research about how the work we do is linked to chronic disease risk, we can talk more about that if that's of interest, but for those reasons, we really think that the influence of your supervisor, who controls so many aspects of your work, is a more powerful influence for most people than their experience at the doctor's office once or twice a year.

Brent Stewart: Let's talk a little bit about that. Let's go into the connections with chronic disease, because this is some statistics that we sign off in as well. Let's talk about that for a second.

Dr. Casey Chosewood: Yeah. I think it's quite intriguing, and there is a growing research base about the connection between work, the exposures that we have at work, both the ones that are obvious. Like we know that exposure to asbestos can certainly lead to certain poor health outcomes that lead to an early death, like mesothelioma, for instance, but we have this far-expanding knowledge base now that's linking certain working conditions that may be quite subtle, that people haven't thought about before with significant, poor health outcomes. For instance, we know that some jobs are strongly tied to obesity. There are some jobs that have almost a take-home benefit of gaining weight.

Good example of that is a long-haul truck driver. Up to 75, 80% of those workers will become obese after just a short time on the job because of the sedentary nature of that work, because of the long hours of work, the constant vigilance that's required to do that job, the stress of that work. We know that certain jobs are strongly associated with obesity. Of course, obesity is a strong risk factor for many other poor health outcomes like heart disease, diabetes, certain types of cancer are related to that. Not every job predisposes to obesity in the same way, and this is a good example of how work and working conditions can lead to difficult working situations and poor health outcomes.

The other thing we're seeing is the connection between workplace stress, and I know that's a very important issue that most employers are dealing with today. We get lots of consults from companies that come into NIOSH, and oftentimes, one of the leading challenges that employers identify is the high levels of stress that their workers report, and we know that stress is a common pathway for a lot of poor health outcomes. Early on, we see increased risk for depression and anxiety for substance use disorders, for other mental health outcomes as a strong linkage between high rates of workplace stress, but long-term, we see things like cardiovascular disease increase as it relates to exposure to workplace stress. There are some who estimate that one in five cases of cardiovascular disease, 20% of heart disease risk in the country is related to workplace exposure, and that obviously is important, because heart disease is the leading cause of death for Americans, and to believe that one in five cases might be work-related is sort of a strong indictment of the exposures at work and how they can influence one's health. Other good examples are how shift work is associated with certain poor health outcomes.

If you work the night shift or the evening shift, you are at quite a bit higher risk of certain health outcomes like diabetes, obesity, and certain types of cancer, even the severity of stroke. If a person were to have a stroke, the severity increases if they're a night shift worker versus a day shift worker. So we have this expanding knowledge base that really does tie work and the conditions we experience through our job to a host of chronic disease conditions.

Brent Stewart: When it comes to employers, what can they do with this information? How can they synthesize this information? And you said that they come to you in terms of thinking about workplace stress. How should they synthesize that information?

Dr. Casey Chosewood: Yeah. I really like that question because it really gets to, "How do you translate this sort of emerging evidence base that connects work, work stress, working conditions with poor health outcomes? How do you connect that with, really, day-to-day changes and practices and interventions that can really make a difference in the lives of workers?" Perhaps, a good place to start is, for me, to recognize the hard work of Barry-Wehmiller and all of your leaders in really putting people at the center of your operations, because I would say that if there was one way that we improve the quality of work, the quality of working conditions, the working life that people experience day in and day out, it is really to put people at the center, if you will, of the process, and I think some of the work that you guys are doing has really supported a people-centric approach to leadership and to running all of your lines of business, so congratulations for that. We, at NIOSH, are very interested in what we call the Total Worker Health approach, and that is seeing workers as not just a cog in a wheel, not just as part of the machinery, if you will, but really as living, breathing entities that have a lot to give to an organization.

We also believe in the philosophy that taking care of people will help you take care of your organization, and I think that would likely resonate with your philosophy as well. The focus on strong leadership as the centerpiece of a high-quality company and subsequently a high-quality work experience is also, I think, central to the Total Worker Health approach. We're very much interested in how leaders demonstrate commitment to the health of their workforce, how they supervise, if you will, with health outcomes in mind, not just productivity outcomes in mind. The Total Worker Health approach really is taking a comprehensive approach. We're interested in moving beyond what most organizations do in the workplace wellness space. We don't discount the value of workplace wellness, but we think if that's the sole focus of most organizational interventions around health, it leaves a lot of opportunity on the table.

It's more powerful to swim upstream and not focus only on just individual behavior change, like eat healthier and exercise more, and, "Hey, take this resiliency building class or this meditation class so you can get rid of your stress." It's much more powerful to swim upstream to change those company level, organizational level policies and practices that actually make all those health decisions downstream possible. So what does that mean? It means taking a look at what the people in your organization need and want to be more healthy. We like to say it isn't if we build it, they will come, it's if they build it, they will come.

So the Total Worker Health approach is all about increasing those practices, policies, and programs that arise from a participatory approach, where workers themselves build what they need, they influence the policies in an organization so that at the end of the day, their health needs are being met, their organizational needs are being met. What does this look like on the ground? It looks like increasing the flexibility that we give to workers, increasing the recognition of their contributions, taking steps to build their engagement. And in many ways, you guys are leaders. Barry-Wehmiller is leaders, really, are leaders in the fields when it comes to putting some of these worker-centered policies and practices in place.

In fact, I think a lot of organizations could really benefit from following the model that you guys have put in place. We really think that there are tons of ways to demonstrate commitment to the health of your workers. I mentioned flexibility, rewards and recognition, looking at leave and benefits policies, obviously wages. Wages are an important way to improve health. We know that perhaps one of the most efficient ways to improve health outcomes is to increase wages.

Not every company can do that equally. There are constraints on that, but wages are a powerful determinant of health outcomes, giving more flexibility and benefits design and benefits choice-making, and something as simple as not sending emails late at night, not expecting a return reply after hours, keeping family-centered policies around leave and flexibilities around that, giving workers a more participatory voice, if you will, more agency and decision-making. Those are other ways that we see the Total Worker Health approach being most important.

Mary Rudder: So how do you find organizations, or do they find you, and then how do you help deploy some of your ideas in these practices?

Dr. Casey Chosewood: Yeah. We are very much interested in taking the research that we learn through a number of sources, and I can give you a little bit more information about our research portfolio, and not just stopping there, but actually translating it, if you will, moving that research into practice. But perhaps most exciting is our Total Worker Health Affiliates program. This is a network of about 50 academic organizations, member organizations like National Safety Council or the American College of Occupational and Environmental Medicine, other membership organizations, the American Industrial Hygiene Association, and others, as well as other federal agencies, NASA, for instance, the National Institutes of Health. Those are Total Worker Health affiliates as well, large healthcare systems like Dartmouth Hitchcock Medical Center or Mount Sinai Health Systems.

These 50 affiliates across the country really serve as our learning laboratories. They're not funded by NIOSH, but they have agreements in place with our Total Worker Health program to put this research into practice, and we learn from the experience of these 50 on the ground sort of living laboratories, and we then take that information and share it more broadly to employers. We've also done a number of consult calls with employers who have a significant challenge that they're facing to help them brainstorm solutions, to tell them about the research that we're aware of that might be applicable and help them develop interventions. Occasionally, we will even do some joint research with an employer as well. We have current projects going with GM, and Toyota, and a couple of other companies that are quite exciting as well.

Mary Rudder: What is the scope of that research that you do with those companies?

Dr. Casey Chosewood: Yeah. For instance, at GM, we're looking at how we can better develop age-friendly interventions for an aging workforce in a manufacturing environment, how we can both decrease the risk for injury as workers get older and may have underlying chronic health conditions, but also how we can use workplace interventions to help them better manage chronic disease, help them better manage work stress. So we do a number of surveys before and after intervention to look at the effectiveness of these programs and training. And if you look at most of our interventions, like many of the programs that you guys put in place in your own workplaces, we focus largely on how leadership influences these things. We don't really focus on individual behavior change.

Obviously, we know that's important, but we really try to say, "What is it at the organizational level? How do they make possible, these intervention changes, these health behavior choice-making and changes? What is it about the structure of the day-to-day work experience, and the management, the supervision, the leadership? How are they influencing these outcomes?" We just think it's more powerful to focus on those upper rungs, if you will, of influence, as opposed to just focus on, "Hey, let's help this person eat a better diet."

We really say it's so many important components of the way work is organized, the way work is structured, the relationship between supervisors and workers. That's a very and a much more powerful influence.

Mary Rudder: And are there some general themes that come out of all that research at these companies?

Dr. Casey Chosewood: Yeah, there are some sort of recurrent themes. I mentioned that we get a lot of questions about work stress because that's a critical area for most organizations. In general, manufacturing technology is moving at a faster pace than ever. We are in a global economy where 24/7 responsiveness and connectivity is driving the pace of change and the pace of work, so work stress is a central theme of many of the consults and many of the programs that we either research or study. We're also very much interested in ways that we can reduce the acute injury from work as well.

So another emerging theme is, "How can we improve the injury risk, the injury rates of working conditions as well?" And obviously, work injury is a bigger issue in some industries and occupations than others, but even in office-based work, there can be musculoskeletal issues, slips, trips, and falls, so workplace injury prevention is obviously a very primary focus of NIOSH. We are at the National Institute for Occupational Safety & Health, and obviously, decreasing work injury is a very critical part of the Total Worker Health approach. If you look at the outcomes of a mature Total Worker Health intervention, in general, the first thing that improves is workers' compensation costs. Acute injury risk goes down first by focusing on safer work, and it's downstream, where you get decreases in healthcare spending.

That usually comes two, three plus years down the road. The return on investment of chronic disease prevention and health costs savings usually is multiple years after intervention, but early wins are things like injury risk going down, workers' compensation costs going down, better engagement, less turnover, more commitment, and more happiness, more job satisfaction from workers. Many of the issues that you guys have reported in your own work, workers that feel valued, feel cared for, feel respected, feel supported are happier to come to work each day. Perhaps a simple story, we like to look at sort of three types of companies. First company will send workers into work, and at the end of the day, because they're not protecting them from hazards at work, they will send those workers home at the end of that day with less health than when they arrived.

So basically, people in those bad companies, we would call them, are asking their workers to trade their health for wages. Obviously, that's not something we would support. A good company at least will protect their workers from the hazards of the job. They will keep them safe, keep all 10 fingers and toes so that those workers go home at the end of the day with the same level of health. That's a company that's at least following the law, but a great company is a company that does that, and then over and above just protecting someone's safety at work.

They invest in that worker's health and well-being, and you say, "Well, okay, that sounds great for the worker, obviously, and it sounds good for their family because they take that health home, and that translates into better health outcomes for the family and for the community in which they're a part of," but here's the hidden secret to that third company's approach. Those workers who went home at the end of the day with more health than when they arrived, they come back to work the next day with that greater level of help, and that greater level of help that each employee arrives with every day translates into fewer injuries, better productivity, decreased healthcare spending, less turnover, less likelihood to make an error in the work, or to have reduced quality of work. And who benefits then? The organization benefits as well. So this sort of circular positive additive approach that continually says there's value for everybody in investing in the health and well-being of the workforce is really at the heart of it, what Total Worker Health is all about.

Mary Rudder: And then if you take that one step further, they're better spouses, and parents, and members of their community, and so actually then, therefore, a better job actually is helping create a better world.

Dr. Casey Chosewood: I really love that theme. We oftentimes forget that companies are part of communities. Not only are they strong influencers and a strong economic engine, but organizations, employers benefit from strong, healthy communities because that's where they're bringing in their workers. That's the pool in which they're choosing and selecting who represents their brand, who represents them to their customers and clients. So it really is a good example of how investing in a community, both the workers that are part of the community, as well as the community as a whole, even not folks who don't work in your organization, really does benefit the bottom line and the reputation of the company at large.

Brent Stewart: Talking about stress at work, can you expand a little bit upon that and talking about the causes of stress at work, and then the effects of that as well?

Dr. Casey Chosewood: Yeah, absolutely. And I think that, as I mentioned, it's such a common, it's so pervasive of an issue that employers are facing, that I think it is worth spending more time delving a bit deeper into that topic. We know that, and I've already mentioned some of the health effects, some of the direct health effects of stress at work, both in the connection to poor early mental health outcomes oftentimes, and even something as more subtle as how stress can oftentimes be a distracting force and increase the risk for injury and illness related to work as well. We can't forget that, that oftentimes, folks who are stressed because of the demands of work and not being able to meet those demands are going to be more prone to error to injury, to less than optimal interaction with coworkers, with management, with clients, that sort of thing. So stress has this sort of, unfortunately, this very common pathway of leading to multiple negative outcomes.

At its heart, stress is really when demands are exceeding the sort of resources that workers have to meet those demands. And in general, the demands of work are determined by leaders, by management, so that really says that leadership has a strong role in making sure that the demands placed on workers are well-balanced by the resources, the reserves, if you will, the supports that they have to be able to meet those. And stress, we have more than three decades of research at NIOSH on the health impacts of work stress, including some of those acute changes around injury, the acute influence on mental health outcomes, especially anxiety disorder, depression, and then more recent emerging health information about work stress' connection to some of the chronic disease states like heart disease. So we think it is a powerful influence in the overall set of risks that a lot of workers face. We know that there are sort of a number of common pathways that stress presents itself.

One is the high demands that I mentioned. The other is long hours of work and the fatigue that comes from that without adequate rest breaks. So a good example here would be all of the burnout and the stress related health outcomes, including even suicide risks that we've seen in certain professions. A good example would be physicians and training, veterinarians, others with high rates of suicide and high rates of burnout and mental health disorders related to the stressors of long hours of work and very little compensatory rest or recovery time in between shifts. So the fatigue that comes from long hours of work is another quite a bit of contributor to stress.

We also see stress common in occupations that require constant vigilance, and perhaps a good example of that would be people in emergency operation centers, or police officers, or they're again, the long-haul truck driver who can't take their eye off the road for even a few seconds. So the stress of constant vigilance in the nature of one's work is another common theme that we see leading to high levels of stress. We also know that stress can cause cognitive impairment. When you are stressed, when you don't feel like you have the resources to meet the demands being placed on you, your decision-making isn't very good. You're more prone to conflict with those people around you.

We know that the health effects of stress lead to higher absenteeism in organizations. It leads to more turnover, certainly productivity suffers, not to mention the healthcare expenditures that come from some of these acute health and chronic disease conditions that we talked about. I, as a practicing occupational health medicine provider, oftentimes would see people who had high stress jobs, high demands that would lead to a mental health disability, and they would be away from work for months at a time, far longer absences oftentimes than someone who got injured with a musculoskeletal condition. They might be off work for a week or two. Someone with a depression disability could be away from work for one to three months.

It was not uncommon. Most employers report that mental health conditions are an increasing expense to their healthcare, bottom line, and unfortunately, mental health conditions, oftentimes related to stress, are lifelong diagnoses. There's something that must be treated and managed over a lifetime. Oftentimes, mental health conditions occur earlier in a worker's life than a chronic condition like heart disease or diabetes. It is not uncommon for depression or anxiety to present in our 20's or 30's, as opposed to heart disease or diabetes may be presenting at age 50 or 60, so the lifetime toll, and the expense, and the disability related to some of the mental health conditions can be quite difficult.

The good news is there are things that can be done to decrease the stress in most workplaces. And I would say, if I only had a dollar to invest, I would invest at least half that in training our managers and our leaders how to create better working conditions, because they really are the key to decreasing workplace stress. The other investment I would make is in giving workers more voice, more participatory influence on their own conditions of work, giving them flexibility on when and how they do their work, not so much what outcomes you expect because every worker understands that, "Hey, I've got to produce X," but how I get from A to X really probably allows for a lot of flexibility, a lot of individual control on how I get to that final product outcome. That level of day-to-day agency, decision-making, control over my working conditions is very powerful. Helping people see the value of strong interpersonal relationships with the people they spend time with at work is another valuable way to decrease stress.

Giving people a voice, really, to help them say, "What are your main stressors? How can we as an organization help fix them?," I think is, perhaps one of the most powerful ways that we can impact the health outcomes that come from high stress work.

Mary Rudder: So as a consequence of our, perhaps greater enlightenment about all this, is there a changing face of organizations? Are there well-being teams looking different these days? Can you speak to anything along those lines?

Dr. Casey Chosewood: Yeah, that's a great question, because we're increasingly hearing of well-being officers or top-performing organizations, chief well-being officer, just like you have a chief operating officer, a chief financial officer. We are all for taking a much broader approach to worker well-being than has traditionally been done in the past. In the past, we usually had a workplace wellness program that focused on, "Well, let's have a gym at work," or, "Let's make sure our cafeteria is healthy. Let's give a lunch and learn on diabetes." Those things are all great, but they will not be nearly powerful enough to overcome eight, 10, 12 hours of difficult working conditions.

They, by the way, at some of these changes on the margin and some of the health challenges on the margin, but the way we're going to really change the health trajectory of workers is by improving the day in, day out conditions of work by decreasing the perceived and real stress levels of our workplaces and our working conditions, and that gets back to how we lead, how we manage people, how much voice we give them, how much flexibility we offer them, how we recognize and reward them, including wages, including good benefits. Those are the things that employees tell us that really make a difference. "Am I respected at work?," "Am I rewarded?," meaning, wages and other recognition, "Am I given some control over the aspect of my workday?" One of the examples that I think is pretty amazing is how Barry-Wehmiller removed the cages around their supplies. To me, that is such a very visible way to say, "We trust you, we value. You're part of our team."

It's not a we versus them, it's we're all in this together, and allowing that self-serve in your break areas and cafeterias is another good example of the trust that you're extending to members of the family at work. All of that, to me, gets back to appropriately recognizing, rewarding, keeping people at the center of the operation. If you take care of your people, they will take care of your organization.

Brent Stewart: Are there any case studies that come to mind when you talk about this stuff that might be good examples to talk about or good illustrations of some of the things that you've been saying?

Dr. Casey Chosewood: Yeah, I really love sort of the storytelling that comes from case examples, and I will refer people to our website. You can just Google Total Worker Health. We have a whole section of our website dedicated to promising practices, and it really does ... It's basically just 30 or 40 stories, if you will, of companies who said, "Hey, we had this problem. We use the Total Worker Health approach to put this intervention in place, and here's our outcome."

A good example is L.L.Bean. You know them as a catalog company from New England. They were struggling with an older workforce. People loved working for the company, and they had been there for 25, 35, 40 years, so their workforce was aging out, if you will, and they were seeing an increased risk for injury related to older workers doing lifting and warehousing, especially difficult work around the holidays. So they really said, "Hey, we don't want to let these workers go. We want to find solutions where these workers can remain on the job."

So they brought all their workers together. They said, "What are your challenges? What are the things that we can help you with?," that led to them getting some new lift equipment, some vacuum suction devices that would help with package lifting, they changed some of the ergonomics of their warehouse to really facilitate the needs of their older workforce, getting the input of those workers along the way, changing some of the demands, bringing in extra help around the busy times of the year, and they were able to not only really build a greater rapport and relationship with those workers, but lower their injury rates, their absenteeism from injury rates as well, cost savings overall, and the investment in the new equipment was certainly paid for by the cost savings from decreasing their injury and illness risk. So that's just one example, but our website really tells the story of a lot of companies of different sizes, organizations that have put in place an aspect of Total Worker Health, or really, a much broader comprehensive program. The good news is with Total Worker Health, is you don't have to do everything all at once.

In fact, we say, "Perhaps the best way to start a Total Worker Health intervention in your program, in your own organization is to do a couple things." One, we say, "Hey, where are your injury and illness hotspots, or where are your absenteeism hotspots?," and perhaps focus there first. Dartmouth Hitchcock has done a great job of developing tiger teams that look at those hotspots within their organization. They're a large medical hospital, medical inpatient, outpatient complex with tens of thousands of workers, and they looked at, "Where are our most injury-prone areas? Where are parts of our organization that have the highest turnover, or the highest needle stick rates, or the highest slips, trips, and falls?," any of their sort of red flag areas, and they sent a tiger team in with worker representatives, leadership representatives, safety and health representatives, occupational health representatives.

They sent a tiger team in to talk to the people in that part of the organization where there was a problem identified, and said, "What are your challenges? What are the needs of your organization? What are the stressors that your workers are facing?," and then they help them with solutions. I love the fact that you don't have to do everything all at once. You can drill down and start with the most challenging part of an organization. We know that there's some workers in every organization who are higher risk than others.

Oftentimes, that's a good place to start when you're thinking about Total Worker Health interventions. Lower wage workers, in general, have more challenges. They have jobs that are oftentimes more dangerous and more at risk, so you don't have to have one-size-fits-all for Total Worker Health interventions. It's okay to say, "What part of our organization could benefit first or could benefit most?," and that's really the beauty of this sort of customizing your approach.

Mary Rudder: Do you have a sense of where we're going? You talked about the three types of companies. Is there a greater pull for the work that you do because you're sensing there's more kinds of companies that are the number three type?

Dr. Casey Chosewood: Yeah. We're really heartened by a couple of things. For those who are obviously following the sort of state of the national economy, we know that workers are getting harder and harder to find, right? Unemployment figures are at some of their lowest ever in 50 years or more, so we know that workers are in high demand, and that's certainly true in certain industries and occupations compared to others. So because of that, we do believe there is quite a bit of incentive now to think more broadly about making the work experience more meaningful, more engaging, more valuable to the workers so that they stay on the job, so that they're not lured away by a competitor.

So we're hopeful that this environment will really encourage employers to take a much bolder look at their current approach to benefits design, to quality of work, to quality of leadership and supervision as key ingredients in successfully attracting and retaining a high-quality workforce. We also think this is a time when workers can demand more from employers because of their relative shortage in the economy right now. So we're hopeful that this sort of set of forces will align to have organizations put more emphasis, very much as you guys have already done on keeping people and the needs of those workers at the center of their decision-making. We're also struck by the quickly arriving, really, head-spinningly fast, the arrival of new technologies and how that's going to influence the future of work. So one of our major, most recent research projects has launched around, really, optimizing the worker experience in a rapidly changing economy, a rapidly changing, a tech-centered way that work is being done.

Even some of the most regular routine work is being quickly replaced and influenced by artificial intelligence, exoskeletons, advanced manufacturing, other new technologies that are changing the way the human experience with work is really realized. So we're trying to find ways to influence all of those changes by keeping people at the center of the decision. Technology is oftentimes the driver of so many decisions at the company level. We think there may be harms that can arise from that, so we would say even when decisions are being made about technologies that are going to influence and benefit a company in the future, people need to be considered the very centerpiece of any decision related to new technology, to new acquisitions, to new ways of doing work, because people, at the end of the day, are really meant to be served by technology, not the other way around.


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